DIAGNOSIS OF NON-CORONARY HEART DISEASES IN PATIENTS WITH VENTRICULAR TACHYARRHYTHMIA

To study etiology of non-coronary ventricular tachyarrhythmia (VTA) based on the assessment of the endomyocardial biopsy data, 87 patients aged 39.9±1.7 years (50 men; 57.5%) were examined. The study group included 41 patients (47%) with episodes of sustained ventricular tachycardia (VT) and 46 patients (53%) with ventricular premature contractions (VPC) and/or non-sustained VT. Electrocardiography, 24 hour ECG Holter monitoring, echocardiography, magnetic resonance tomography with contrasting and in the fat suppression mode, stress test, and coronary angiography to exclude the VTA ischemic origin were performed. The endomyocardial biopsy was carried out in the area of surgical treatment of the arrhythmia, which included catheter ablation and/or implantation of a cardioverter-defibrillator. According to the data of endomyocardial biopsy, arrhythmogenic cardiomyopathy/right ventricular dysplasia (ACRVD) was diagnosed in 29 patients (33%), myocarditis, in 34 patients (39%), and postmyocarditic cardiosclerosis, in 24 ones (28%). The histological study of myocardial biopsy samples of the patients with ACRVD showed lipomatosis, microfocal fibrosis, as well as dystrophy and atrophy of the right ventricle muscular fibers. Signs of active myocarditis were found in 7 patients, of chronic myocarditis, in 2 ones. The relative area of lipomatosis was 34.3±14% (3 90%); 32.7±13.4% in patients without myocarditis and 42.1±22.3% in patients with myocarditis. The relative area of fibrosis was 36.7±18% (2 90%); 30±15% in patients without myocarditis and 37.2±17.2% in patients with myocarditis. Thus, the endomyocarial biopsy permits one to determine etiology of VTAs considered “idiopathic” during the standard (typical) non-invasive study. The most frequent causes of non-coronary ventricular arrhythmias were ACRVD (33%), myocarditis (33%), and post-myocarditic fibrosis (28%).

arrhythmogenic cardiomyopathy/right ventricular dysplasia, myocarditis, postmyocarditic cardiosclerosis, ventricular tachyarrhythmia, endomyocardial biopsy, echocardiography, magnetic resonance tomography

1. Бокерия, Л.А. Желудочковые аритмии (современные аспекты консервативной терапии и хирургического лечения) / Л.А. Бокерия, А.Ш. Ревишвили, А.В. Ардашев // М.: Медпрактика, 2002, 272 с.

2. АСС/AHA/ESC 2006 Guidelines for Management of Patients with Ventricular Arrythmias and the Prevention of Sudden Cardiac Death // J. Am. Coll. Cardiol. - 2006. - Vol. 48. P. 1064-1108.

3. Aliot, E. EHRA/HRS Expert Consensus on Catheter Ablation of Ventricular Arrhythmias / E.M. Aliot, W.G. Stevenson, J. Almendral-Garrote [et. al] // Europace 2009. - V. 11. - P. 771-817.

4. Шляхто, E.В. Идиопатические желудочковые нарушения ритма: результаты проспективного наблюдения / Е.В. Шляхто, Т.В. Трешкур, Е.В. Пармон [и др.] // Вестник аритмологии, 2004. - № 33. - С. 5-11.

5. Миокардиты. Стандарты морфологической диагностики при аутопсии и эндомиокардиальной биопсии / под редакцией проф. Б.Г. Ковальского. Издательство Спб ГУЗ «Городское патологоанатомическое бюро», 2010. C. 15-20.

6. Aretz, H. Myocarditis: a histopathologic definition and classification / H. Aretz, M. Billingham, W. Edwards [et. al] // Am. J. Cardiovasc. Pathol. - 1987. - V. 1. - P. 3-14.

7. Pieroni, M. High prevalence of myocarditis mimicking differential diagnosis by electroanatomic mapping - guided endomyocardial biopsy / M. Pieroni, A. Dello Russo, F. Marzo [et. al.] // J. Am. Cardiol. 2009. V. 53. P. 681-689.

8. Shultz, J. Diagnosis and Treatment of viral myocarditis / J. Shultz, A. Antony, A. Hillard [et. al] // Mayo Clinic Proc. - 2009. - Vol. 84, p. 1001-1009.

9. Mason, J. Myocarditis Treatment Trial Investigators. A clinical trial of immunosuppressive therapy for myocarditis / J.Mason, J.Oconnel [et. al] // N. Engl. J. Med. 1995. V. 120. P. 569-573.

10. Kuhl, U. Myocarditis: early biopsy allows for tailored regenerative treatment / U. Kuhl, H.P. Schultheiss // Dtsch. Arztedl. Int. 2012. V. 109 (20). P. 361-368.

11. Cooper, L. The Role of Endomyocardial Biopsy in the Management of Cardiovascular Disease: A Scientific Statement From the American Heart Association, the American College of Cardiology, and the European Society of Cardiology / L. Cooper, L. Kenneth, A. Baughman // Circulation. 2007, V. 116. P. 2216-2233.

12. Strain, J. Results of endomyocardial biopsy in patients with spontaneous ventricular tachycardis but without apparent structural heart disease / J. Strain, R. Grose, S. Factor // Circulation. 1983. V. 68. - P. 1171-1181.

13. Sekiguchi, M. Endomyocardial biopsy approach in cases with ventricular arrhythmias / M. Sekiguchi, M. Nishizava, S. Nunoda [et. al] // Postgrad. Med. J. 1991. - V. 68. - P. 40-43.

14. Грохотова В.В. Аритмогенная кардиомиопатия правого желудочка: проблемы интервенционного лечения желудочковых тахиаритмий / В.В. Грохотова, Д.С. Лебедев, Р.Б. Татарский [и др.] // Сибирский медицинский журнал. - 2013. - № 1. - С. 23-28.